Neurosurgeon and attorney Dr. Larry Schlachter makes a case that most patients enter the healtyhcare system without any idea of the risks they face, due to a medical culture that denies there is a patient safety problem. He argues that medical culture actively avoids transparency, perpetuates an atmosphere of blind deference to doctors, and protects dangerous doctors from any accountability.
Drawing on 23 years of experience, Dr. Schlachter provides unbelievable stories that illustrate the host of risks patients face whenever they seek diagnostic evaluation or go under the knife. This book provides an all-access pass to the inner sanctums of the health care citadel, exposing the cultural flaws that fuel doctor’s egos and outlining the steps every patent should take to protect himself or herself.
“Malpractice is an honest view of what our broken health-care system looks like. We lost our only child to preventable death because the system allowed an incompetent surgeon to practice. Dr. Schlachter analyzes the challenges facing patients and caregivers in a way health-care consumers and professionals alike can learn from.” – Patricia J. Skolnik, President, Citizens for Patient Safety, LLC
“Malpractice will not make Dr. Schlachter many friends in the health-care industry, but it starts a conversation we must have if patient safety is truly our goal. We need more doctors like him professionals willing to acknowledge the risks created by a medical culture that puts doctors ahead of patients, and willing to fight for meaningful changes that will lead to better outcomes for patients and providers alike.” – Dr. Marty Makary, Johns Hopkins surgeon, patient-safety advocate, and author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care
Dr. Schlachter brings the same insight and honesty to Malpractice that he brings to examining cases in which patients have been terribly wronged. His astute analysis is a bitter pill for an industry that for many years has avoided the hardest conversations about patient safety, but it is perhaps the only prescription that can save us.” – Dr. Michael Dogali, MDCM, FACS, president of Pacific Neurosurgery
Preface of the book
When you seek health care as a patient, you probably believe that everyone involved is focused on you, is alert, caring, and competent, and that when they operate on you, they know W W exactly what they are doing. You trust that your health-care providers are people of integrity, and if they made a serious mistake that harmed you, they would be honest about it.
Unfortunately, the truth is that every doctor who has been practicing for any length of time has harmed a patient. Nobody bats 1.000. Many doctors, if not most, have killed at least one patient. Some of these injuries and deaths are unpreventable. However, the horrible reality is that hundreds of thousands of pa- tients die, and many more are forever maimed, by preventable medical errors every year.
According to the article, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care” in the September 2013 Journal of Patient Safety, about four hundred thousand patients in American hospitals are carried out in body bags each year, their premature deaths associated with preventable medical error. The same study estimated that another four to eight million patients are seriously injured by medical error each year.
A more recent study, published in the journal BMJ (formerly the British Medical Journal) in May 2016, identified medical error as the third leading cause of death in the United States, behind only heart disease and cancer. Led by Johns Hopkins surgeon and patient safety advocate Dr. Martin Makary, the study found that if medical error were officially tracked as a cause of deat that it is not tracked is a major problem of its own—it would be blamed for at least 250,000 deaths annually.
To make matters worse, most of their victims are left with no recourse. Those who pursue legal action often meet a court system heavily weighted in favor of doctors and their insurance companies. With very few exceptions, most danger- ous doctors continue to practice medicine. Most doctors have never been sued, and of those who have, a majority won their cases. Very few of these negligent doctors are ever sanctioned.
Among the general public, doctors get the benefit of a huge halo effect. We routinely accept their diagnoses as being accurate, even though studies have shown that anywhere from 10 to 20 percent of diagnoses are delayed, missed, or alto- gether incorrect.
Victims of negligence often accept doctors’ explanations that a tragic outcome was unpreventable. There are a thousand places where incompe- tence and negligence can hide in a hospital and within the medical culture. If a seminar leader were to ask a large group of doctors how many of them know an incompetent or dangerous doctor, most hands in the room would go up.
The vast majority of medical malpractice never becomes known outside of the hospital. Most medical error is not egregious or catastrophic enough to warrant the huge investment of capital to take it to court. Medical error is commonly buried in the hospital where it took place, never making it into the records, or the records are altered. Patients and their families have no way of knowing what happened to them, or whether their doctor is lying to them.
This is the world I live in, and I know it to be true. I am a licensed physician, a board-certified neurosurgeon, and a lifetime member of the American Association of Neurological Surgeons. I am also a plaintiffs’ attorney and I sue medical practitioners for malpractice when I think the preponderance of evidence justifies that conclusion. Mine is an unusual combination of talents and circumstances, and I will tell you more of my story in the coming pages. I have a doctor’s heart and compassion for both patients and doctors; I also have a lawyer’s awareness that great harm is sometimes done by physicians to patients through narcissism, carelessness, or ineptitude.
As a blue-collar Brooklyn boy, I graduated from a New York City public high school and college. I became a dentist, then a doctor, and eventually a neurosurgeon. I gravitated to neurosurgery because I knew it would demand the very best of me, and I loved the science of it. Today, as a forensic scientist, I apply what I know about the human body in general and neurosurgery in particular to determine if patients with terrible outcomes have been victims of professional negligence. Mine is a highly technical field, and every case I look at has tragic human overtones.
For obvious reasons I have had to change names and some nonmaterial details to respect patient privacy and stay on the right side of the law. Many, if not most, cases of medical malpractice are settled with an agreement to be silent about the outcome, meaning none of the parties are free to disclose details of the settlement, including culpability of the medical practitioner. As you might imagine, the purpose of this agreement is to protect the doctor, not the patient.
I have great respect for the majority of neurosurgeons and other physicians who share my high ideals for our profession and who work hard every day to live up to them. The problem is that there are a number of doctors who should not be practicing because they are not only inadequate at what they do, but also dangerous.
Another major concern is that the system of health-care delivery does not demand physician accountability or full disclosure to patients. Consequently, when mistakes are made, they are not properly investigated and victims are not treated fairly. In spite of the so-called patient safety movement, hubris and greed prevent the system from policing itself successfully. In this milieu, patients have little recourse but to engage attorneys to seek redress for harm that was done to them and, especially, to discover the truth of what actually happened to them.
I do not expect to win friends in the medical profession with the writing of this book. As we will discuss later, the medical culture is insular, protective, and incredibly hostile to any from within or without its ranks who would dare to question their authority and expertise. They reserve a special ire for plaintiffs’ attorneys who represent patients. This anger is manifest by some doctors who come to court as expert witnesses and defend negligent physicians by presenting dishonest testimony.
To listen to doctors, insurers, media, or politicians, one might conclude there is not much of a problem with medical errors in American health care. In fact, these protectors of the status quo swear that there is a radical infestation of predatory plaintiffs’ attorneys who inspire fear in the heart of every conscientious and dedicated physician in the country. This is the cause, they claim, of dramatically rising health-care costs, and the burden to our justice system of frivolous lawsuits and mind-boggling jury awards for damages.
Though I will address many of these myths, I am not writing this book as an apologist for the plaintiffs’ bar, nor am I interested in diminishing respect for my profession as a neurosurgeon. I have lived both sides of this great divide. Eighteen years of my adult life have been invested in higher education to become a highly skilled practitioner in my specialty, one of the most demanding in medicine.
My book is intended for patients, which includes all of us, because sooner or later we will all need medical care. When that day comes, we want to believe that medical practitioners and hospitals are held to the highest professional and ethical standards. Regrettably, this is not the case. Insiders are well aware of this. Patients, on the other hand, rarely understand that the hospital can be a very dangerous place and that errors and negligence are commonplace, and, even worse, intentionally covered up.
This book is about the harm doctors do to patients, and the tortuous path patients must take to learn the truth of what happened to them and to find justice. It is about the culture and attitudes that make mistakes more prevalent than necessary. My writing treats tort reform as what it is a circus sideshow designed to divert attention away from the dangers of American health care.
The real concern of this book is that there are unnecessary and preventable injuries occurring in our healthcare system. They need to be reduced as much as possible.
We must get our priorities straight.
Larry Schlachter, DDS, MD, JD
retired neurosurgeon and now a malpractice attorney.